opp 1 midterm Flashcards
When was A.T. still Born
August 6th 1828
What job(s) did A.T. Still’s father have?
Farmer, methodist minister and a physician
**methodist ideals big on education, rest,diet, antislavery
Describe Heroic Medicine
Benjamin rush believed all illness was caused by fever due to blood tension
People avoided physicians due to treatments
Describe Heroic medicine treatments
Bloodletting
Purging (stomach and bowel)
Calomel and other poisonous compounds
*Calomel led to mercury poisoning and loss of teeth, gray tongue and blood diarrhea
When was A.T. Stills first experience with Osteopathy?
When he was 10 years old he had a tension HA. He took a line in between 2 tress and put a pillow on the rope, fell asleep, and when he woke up his headache was gone.
When did A.T. Still decide to become a physician, who trained him and who were his first patients?
- 1854 he decided to become a physician while living in Kansas
- He was trained as an apprentice to his father
- His first patients were Shawnee Indians.
Samuel Thomson
Challenged Orthodox medicine. Believed disease was the body’s inability to maintain heat. He gave patients botanicals to cause sweating and vomiting.
Samuel Hahnemann German
Challenged Orthodox medicine.
- He believed the best treatment was to use a substance that produced symptoms of a disease in a healthy person (like cures like)
- Homeopathy*
Sylvester Graham from MI
Challenged Orthodox medicine
-Believed the body could heal following nature’s laws:
exercise, proper diet, no pastries, no fish, no meat, no dressing inappropriately, and no sexual promiscuity.
(Graham cracker was made after him)
Franz Mesmer (Austrian)
Challenged Orthodox medicine
- He believed there is an invisible fluid in the body and when unbalanced caused disease. He tried to balance the fluid with magnetic rocks, trees, bathtubs.
- magnetic healer*
Which side of the civil war was A.T. Still on?
-He was on the Union (methodist do not believe in slavery)
-Surgeon bag contained: saw, opium, cocaine, whiskey, rags and calomel
more people died from dz and infection than war
3 of A.T. Still’s children died in what year and of what disease?
1864 3 of his children died of Spinal meningitis
*He was unable to help his kids (shifts away from heroic medicine)
What year did A.T. Still’s father die?
He died in 1867 of pneumonia
- 3 years after his 3 children died (caused him to shift from heroic medicine to osteopathy)
- A.T. Still raided Native american graves and read all the anatomy books he could find to study.
What year did A.T. Still reject traditional (heroic) medicine?
June 22 1874
“He flung to the breeze the banner of Osteopathy”
“Man as a machine”
His vision was: “Health is maintained by unobstructed blood flow and impulses of nerves”(removal of obstacles through manipulation)
A.T. Still incorporates bonesetting into his practice
1875 “magnetic healer”
1883
known as the “lightning bonesetter”
First school of Osteopathy
- 1892American School of Osteopathy (ASO) > Kirksville College > A.T. Still University
- 1st faculty was William Smith (taught anatomy)
- class was 21 people (18-65) at least “5” were women
- Lecture style was: analogy and parables (he didn’t want students to take notes)
- His students referred to themselves as “anatomical engineers”
Licensing of D.O.s (first and last)
- 1896 Vermont was the first state to license D.O.
- 1973 Mississippi was the last state to license C.O.
When was the American Osteopathic Association formed, and why was it formed?
1897 in Kirksville for: -Education -Legislation -Publication in 1901 M.D.'s made $1500/per D.O.'s made $1200/month
Beginning of Osteopathy A.T. Still treated what, and how did he treat it?
1874-He treated dysentery (flux) by rolling a patients body over a log to restore motion to the spine.After pain left from the abdomen.
- He found that the course of disease was shortened by adjusting a person’s structure
- 1875 known as a “magnetic healer”
When does A.T. Still Die?
December 12 1917.
MD schools and D.O. schools have the same length of study
1920
Spanish flu pandemic 1918-1919
People with OMT had a lower mortality rate (0.2%) vs those without OMT (20%)
Broad vs Lesion Osteopaths
1/2 were Lesion osteopaths (followers of A.T. still) only wanted to deal with structural support
1/2 were broad osteopaths who wanted to incorporate Medications with OMT
Broads won out
What year was Pharmacology taught at all schools?
1927
1920s-1940s an increase in the number of osteopathic hospitals b/c M.D.s were in the war.
Why was there a decrease in OMT in the 1940s?
It was easier and took less time to just give medications
Flexner report
1910: decreased the number of M.D. to 66 and D.O. schools to 7.
- increased all the standards of medical school: added a 4th year, increased entrance standards, and added more clinical work
When was professional autonomy granted to D.Os (being able to work in all hospitals)?
Landmark case in Missouri in 1950
When were D.O.’s allowed to serve in the armed forces
1957
-in 1966 first D.O. was commissioned in the armed services as a medical officer
What was the frustration in California in the 1960s all about?
-lack of state support and poor clinical training facilities
What happened in 1961 in California with the D.O.s and M.D.s.
They merged in the state of California. D.O.s would cease OMT and refer to themselves a M.D.s
(over 2000 D.O.s paid $65 for a weekend course.)
Aftermath of the Merger in California
- General Practitioners were able to practice at all hospitals.
- Specialists had to have a degree from an AMA certified school.
- D.O.s in California were referred to as “little M.D.s” and their M.D. degree was not recognized outside of California.
Which school took the lead in Osteopathic medicine after the events in California?
Michigan state University took the lead in 1970
-first university based osteopathic school as a result of the D.O.s in Michigan
What case was overturned by the California supreme court in 1974?
The amalgamation of M.D.’s and D.O.s in California.
In the 1980s and 1990s there was an emphasis put on what field of medicine?
Primary care
-Health maintenance and preventative care
When was the Merger into one single accreditation system for GME across the country approved by the AOA, and when will it be fully implemented?
It was approved July, 2014 by the AOA, and it will be fully implemented by July of 2020.
Name the 4 Osteopathic principles
- The body functions as a unit. (nervous system connects and integrates all of the body’s functions)
- Structure and function are interrelated(eg. organs and their functions)
- The body possesses self-regulatory mechanisms (eg. blood sugar)
- The body has an inherent capacity to heal and repair itself (skin healing and scabbing after a scab)
Define Osteopathy
A philosophy of medicine which postulates the musculoskeletal system as the primary manifestation of health and disease, and by influencing somatic systems by manipulation
-It is a health-oriented philosphy with a patient-centered focus
(compare to definition of osteopathic medicine)
Define osteopathic medicine
A system of medical practices which embraces all known forms of medical treatment and therapy, incorporating and being informed by the science, philosophy and practice of osteopathy.
Axis vs plane
Axis: line that goes through the body, movement occurs around an axis
Plane: slices the body in halves, movement occurs within a plane
-An axis is perpendicular to a plane
Superior vs inferior axis
Superior: toward the head (up)
Inferior: toward the feet(down)
(through the transverse plane)
Movement: rotation
Anterior vs posterior axis
Anterior: towards the front of the body
Posterior towards the back of the body
(through the coronal/frontal plane)
Movements around this axis: abduction, adduction, and lateral flexion/sidebending
Medial vs lateral axis
Medial: towards the center of the body Lateral: away from the center of the body (aka right left axis) -Through the sagittal plane -Movements: flexion/extension
Sagittal plane
Divides the body into the right and left portions
-flexion and extension occur here
Coronal (frontal plane)
Divides the body into front and back portions
(anterior and posterior axis)
-side bending,abduction and adduction occurs
Transverse plane
Divides the body into superior and inferior portions
(rotation occurs here)
-superior inferior axis
Distal vs proximal
Distal: further away from the center/trunk of the body
Proximal: towards/closer to the center of the body/trunk
Ipsilateral vs contralateral
Ipsilateral: same side of the body
Contralateral: opposite side of the body
Ideal standing posture coronal plane
Coronal/frontal plane: symmetry, upper extremities parallel, feet shoulder width apart, side bending/tilting of the trunk to one side
(observe anterior and posterior)
E.g neck tilted to one side(not centered)
Ideal standing posture Transverse plane
Transverse plane: symmetry, shoulders medial, legs rotated laterally (externally), trunk or neck rotation
(observe anterior and posterior)
e.g. one of the clavicle bones is more prominent due to trunk rotation
Ideal standing posture with the sagittal plane
Sagittal: Proportionally, plumb line relationships, feet in anatomical position, flexion/extension deviations of posture
(observe from the side/lateral view)
e.g. head/neck forward
Physiological curves in the sagittal plane
-Cervical region: concave, normal lordotic curve
-Thoracic region: convex, normal Kyphotic curve
-Lumbar region: concave, normal lordotic curve
-Sacral region: Convex, normal kyphotic curve
Concave = lordotic whereas Convex = kyphotic
Ideal standing posture
“Perfect distribution of body mass around the line of gravity”
Plumb line:
*External auditory meatus * Humeral head
*L3 vertebral body *anterior 1/3 of sacrum
*Femoral Head *Lateral malleolus
Relaxed posture
-Develop with pregnancy and central obesity
Plumb line: Falls posterior, center of mass through heels
Results** 1) Increased lumbar lordotic curve
2) Slight sway of back of upper thoracic spine
Military Posture
Plumb line: posterior Chest/out/elevated, stomach in creating deviation from plumb line Posterior head tilt Normal cervical and thoracic curves Anterior pelvic tilt Knees extended
Plumb line
A weight bearing line that we use as a normal comparative when assessing posture
Ideal sleeping position
- Firm surface
- Lie on one side
- Head on pillow (to keep head and neck in anatomical position)
- Knees flexed (so lower back is resting in slightly round position)
- Pillow between knees
Ideal seated position
Firm cushion (so buttocks does not sink)
Legs parallel to floor
Feet flat on floor
Accomodation
- postural adaptation
- A self-reversing, non persisting adaptation
Compensation
- Postural adaptation
- Result of body’s homeostatic mechanism acting on the whole body unit
- Organized counter balance “functional changes”
- Trying to make the best of a less-than-ideal situation
Decomposition first 3 types (CBG) and definition
Decomposition: The breakdown of compensatory mechanisms
Congenital: Hemivertebra, bone/joint deformity
Body habitus changes: weight gain pregnancy
Gait changes: flat feet, heel changes
Decomposition last 5 types (H,T,SD,LM,MA)
Habits: occupation
Trauma: herniated disc, acceleration-deceleration injurty
Somatic dysfunction: Sacral base unleveling
Loss of muscle tone: Polio
Mental attitude
Define Somatic dysfunction
Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements.
Causes of Somatic dysfunction and examples
i. Somatic disfunction is a result of alteration of the somatic tissues that prevents the components from returning to their resting states
ii. Macro/major trauma: accidents, surgery, giving birth, major diseases
iii. Micortrauma: gravity, irritants to the body, poor diet, lack of sleep, emotional upsets
How to Diagnose Somatic Dysfunction
T : Tenderness
A: Asymmetry
R: Restriction of Motion
T: tissue texture abnormality (eg. edema, cyst, necrosis, heat, fibrosis)
***Only need 2/4 TART symptoms to diagnose
Vertebral motions
Flexion
Extension
Side bending (lateral flexion)
Rotation (whatever way your chest is facing)
Define motion
Motion: a)A change of position with respect to a fixed system
b) An act or process of a body changing position in terms of direction, course and velocity
Active Motion
Movement produced voluntarily by the patient
Limited by a “physiological barrier”
Passive motion
Motion induced by the physician while the patient remains passive or relaxed
Limited by an “anatomical barrier”
Define Barriers to motion
a) The limit of motion
b) A restriction of binding felt when a joint is put through its range of motion
c) An accurate knowledge of “normal rotation” is essential to the diagnosis and treatment of somatic dysfucntion
Anatomical Barrier of Motion
The limit of motion imposed by the anatomic structure: the limit of passive motion
Physiological barrier of motion
The limit of active motion; can be altered to increase range of motion by warm-up activity
Restrictive barrier of motion
A functional limit within the anatomic range of motion, which abnormally diminishes the normal physiologic range of motion
eg tight muscle, scar tissue, edema, tumor, pain, paralysis, fracuture
Pathologic barrier
Permanent restriction of joint motion associated with pathologic change of tissues (eg contracture, osteophytes)
Elastic barrier of motion
The range between the physiologic and anatomic barriers of motion in which passive ligamentous stretching occurs before tissue disruption
Osteopathic Manipulative Treatment (OMT)
The therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis
Osteopathic Manipulative Medicine (OMM)
The application of osteopathic philosophy, structural diagnosis and the use of OMT in the diagnosis and management of a patient
Direct technique
Any technique engaging the restrictive barrier and then carrying the dysfunctional component toward or through the restrictive barrier
Indirect technique
A manipulative technique where the restrictive barrier is disengaged; the dysfunctional body part is moved away from the restrictive barrier until tissue tension is equal in one or all planes and directions
(compare to pulling out a stuck drawer: push it back in before trying to take it out)
Functions of the lymphatic system
1)Maintain homeostasis: a) cardiovascular assistance with fluid management b) Transportation of fats from small intestine to veins
2) Immunologic role a) filter particulate matter
b) Develop and deliver antibodies
Homeostasis effects of the lymphatic system
1) Fluid management: Pathway of fluid return from interstitial tissues back to vascular system (2L/day)
2) Transportation of Fats: a) Lacteals: Lymphatic vessels found on the intestines; responsible from transport of lipids into lymph fluid (chyle)
b) Lipids are then transported to the blood via thoracic duct and sent to liver for further processing
Dysfunction of the lymphatic system
Lymph Flor disruption:
1) Local Interstitial fluid pressures, or ECM strain
2) Systemic:
a) Intrinsic: Contraction of the lymphangion smooth muscles
b) Extrinsic: external forces acting on the lymph vessels
i. Local cardiopulmonary pressures
ii. Venous statsis
Cysterna Chyli
-collecting reservoir from interstinal and Lumbar trunks (abdomen and lower extremities)
-Lymph fluid from the lower body; perineum and abdominal cavity
-Loacated at the level of the lumbar vertebrae (L2)
Drains into the Thoracic duct
Two techniques used to optimize the function of the lymphatic system
Type 1. Those that remove impediments of lymph flow (above clavicle)
Type 2. Those that promote and augment lymph flow
Thoracic duct
- Drains lymph from left head and neck, left arm, left thorax, cysterna chyli (L2)
- empties lymph into the left internal jugular and subclavian veins
- Largest lymph vessel in the body
Right Lymphatic duct
Drains lymph from the right upper extremity, right side of head, neck, chest and right lung
-Returns lymph into veins at the right subclavian vein and the right internal jugular vein
Areas to palpate for lymph nodes and facial restrictions to lymph flow
a) Anterior and posterior cervical lymph nodes
b) anterior and posterior axillary lymph nodes
c) Clavicular Nodes
d) epitrochlear nodes (syphilis)
e) Superficial Inguinal lymph nodes
How are we able to distinguish between lymph nodes and other tissue?
1) press firmly against tissue (bone or muscle) to appreciate discrete structure
2) Size of tip of little finger
3) Non-tender and movable
4) Consistency of grape
Lymphangion
Makes up walls of Lymphatic vessels
Forces that contribute to lymph flow
- Depend on extrinsic forces for propulsion
- Respiratory motion, skeletal muscle contraction
- Intestinal motion, Interstitial pressure
- Oncotic pressure, diaphragm
- Lymph capillaries have no intrinsic propulsion
Diaphragm anatomoy
- Stable on the outside of the parachute and the outside is attached to the ribs, xiphoid process and vertebrae
- Crus: 2, act as a pump fro the cysterna chyli (2 slings that originate by the vertebrae and have a whole where the abdominal aorta is)
- Crura may obstruct flow when tense: eg coughing, prevent full deep breathe
Inhalation (diaphragm)
- Diaphragm contracts and descends
- Air rushes into the lungs
- chest wall expand (sternum and ribs)
- Abdomen bulges out
- Thoracic spine extends
Exhalation (diaphragm)
- Diaphragm relaxes
- Passive recoil of chest muscles
- Air moves out of the lungs
- Chest wall drops down
- Thoracic spine flexes
Diaphragm and skeletal muscle function in the lymphatic system
Both are a major pump of the lymphatic system
*impaired function leads to lymphatic stasis (why bedridden people get worse)
Edema
Accumulation of interstitial fluids in abnormal amounts
Lymphedema
Lymphatic obstruction
- Localized fluid retention
- Tissue swelling
- Accumulation of lymph fluid
- usually affects extremities (~170 million people)
Stages of Lymph edema
Stage 1: swollen limb leaves a pit, describe as “2+ pitting”, can be reversible, elevation of extremity can reduce swelling
Stage 2: pressure does not pit, elevation does not help, can become fibrotic
Stage 3: (aka Elephantiasis) Most lower extremities, occurs in stage 2 is untreated, treatment can help but it is not reversible
Pitting edema scale
1+ = 2 mm (or less) 2+ = 4 mm (or above 2mm) 3+ = 6mm (or above mm) 4+ = 8mm (or above 8mm)
Consequences of edema
- Compression of local tissues (Neural,Vascular and lymphatic)
- Compromised nutrition
- Changes in tissue and organ function
Mechanical conditions that decrease lymph flow
- Kyphoscoliosis
- Poor posture
- gravity
- Decreased respiration
- Abdominal or thoracic surgery
- Pregnancy (compressing on pelvic diaphragm)
How does OMT facilitate lymph drainage
- releases mechanical barriers
- Increases fluid reabsorption
- Increases circulation
- Improves respiration and diaphragm mechanics
Contraindications for lymphatic techniques
- Localized, untreated osseous fracture
- Untreated acute febrile infection (not on fever above 101.5)
- Newly diagnosed untreated cancer
- Certain circulatory conditions (venous obstruction, embolism, hemorrhage)
Treatment of Lymphatics
1) Open superior thoracic outlet
2) Treat the Thorax
3) Treat abdomen/pelvis
Sequence of lymph Treatment techniques
1) superior thoracic outlet
2) 2-3 thoracic techniques
3) 2-3 abdominal/pelvic techniques
4) 2-3 extremity techniques
5) Entire cervical sequence of techniques
6) repeat 2 thoracic techniques
* *Thoracic inlet > proximal(central) > distal (peripheral) > central (double up on)
Combination techniques (2)
1) Still’s technique: involves initially taking the joint away from the restrictive barrier (indirect technique) and then secondarily progressing motion towards the restrictive barrier (direct direction)
2) Myofascial release-Direct techniques, but can also be indirect
Direct techniques (5)
- Soft tissue techniques
- Direct myofascial release
- Muscle energy technique
- Articulatory technique
- High velocity, low amplitude (HVLA) technique
Soft tissue techniques sequence
is the second T in TART (tissue texture change)
- Patient comfort comes first 2. Technique applied to exposed skin
- Clinician body mechanics of utmost importance
- Gentle force, low amplitude first then progress to increased force
- Superficial to deep
- Strokes towards the heart where possible
- Rate of application 1-2 seconds on, 1-2 seconds off
- ‘Good discomfort’
- Do not allow your hands to create friction by sliding across the skin
- Do not compress the musculature against bone
- The technique is continued until the desired effect is achieved
Direct Myofascial release technique sequence
- Contact area where restriction in myofascial structure is perceived
- Engage tissue by pressing into it
- Drag the mofascial tissue superior/inferior, medial/lateral, clockwise/counterclockwise and perceive which direction is most restricted
- Stack these motions towards the restrictive barrier, hold this position until the tissue releases underneath your hand
- Re-check
Articulatory technique
Clinician REPETITIVELY takes the part of the body being treated directly TO the restrictive barrier (eg rib raising)
Indicated for elderly patients suffering from Osteoporosis or OA
Muscle energy technique
- Diagnose somatic dysfunction
- Position joint to the restrictive barrier
- Instruct patient to move limb AWAY from restrictive barrier while clinician resists patient movement for 3-5 seconds with an equal and opposite counter force (isometric)
- Instruct patient to relax,
- Take limb further towards restrictive barrier
- Repeat steps 3-5 until no further improvement is achieved
- Recheck diagnosis (usually 3-5 cycles)
High Velocity/Low amplitude (HVLA) steps
- identify barrier via diagnosis
- bring the joint to the barrier - reverse the somatic dysfunction Dx
- Take all slack out of the area
- Position carefully/fine tune
- use Relaxation/distractor technique
- Apply thrust in a specific direction (HVLA)
- Recheck diagnosis
Neurophysiology of muscle energy techniques
When a muscle brought to stretch at barrier, the muscle spindles begin to activate, which in turn activate the motor neurons to resist the stretch by contraction the muscle. Therefore with regular stretching, there will always be that counter-contraction occurring limiting the effectiveness of the stretch applied.
Post-Isometric Relaxation (neurophysiology of MET)
- During muscular contraction, an action potential generated at neuromuscular junction.
- Refractory period occurs in seconds directly after contraction (muscle cannot fire)
- Allows further stretch towards barrier
Golgi tendon Organ (GTO) (neurophysiology of MET)
During contraction, motor neurons activated.
- Tendon tension threshold reached
- GTO activated which inhibits the motor neuron activity
- Muscle tension reduced
Muscle fatigue (neurophysiology of MET)
The isometric contraction produced several times over, will fatigue the muscle that is holding the joint our of place, allowing restored range of motion
(MFR) Myofascial release (indirect) and indications
The dysfunctional myofascial tissues are guided along the path of least resistance until free movement is achieved.
Indications: MFR is used to treat somatic dysfunctions involving myofascial or other CT of the body
MFR (myofascial release) contraindications
Absolute: Absence of somatic dysfunction
Relative: Extreme caution in patients with Fx, open woulds, soft tissue or bony infections, abscesses, DVT, neoplasm, recent post op, aortic aneurysm
MFR mechanisms
-fascia is capable of length changes
Elasticity: fascia returns to original shape
Plasticity: fascia when under loads can reform into a new shape
Hysteresis: accompanied by conversion of mechanical stress (eg heat)
What is Strain/Counterstrain (Counterstrain)
Indirect treatment in which a somatic dysfunction is Dx by an associated myofascial tender point
-Tenderpoints are near bony attachments,ligaments, or in muscles
Tenderpoints are palpated as small,tense, edematous areas of soft tissue that are about the size of your fingertip
-Locally tender- no pain referral
*Anterior and midline tenderpoints require flexion, Posterior tender points require extension, lateral tender points require rotation
Strain/counterstrain indication
Acute or chronic somatic dysfunctions
- Somatic dysfunctions with a neural component like hypershortened muscle
- As a primary treatment or in conjunction with other approaches
- Somatic dysfunctions anywhere in the body
- need tender points
Strain/counterstrain contraindictations
Absolute: Absence of somatic dysfunction, Lack of patient consent, Fx or torn ligament in the area
Relative: Patient who cannot voluntarily relax, severely ill patient, severe osteoporosis, Vertebral artery disease
-Unable to do on a 5 month old or a comatose patient
Strain/counterstrain Principles of diagnosis
Patient history of body habitus, once an area of dysfunction is determined, the specific tissue locations are evaluated for presence of tenderness and tissue texture abnormalities (increased tension)
Strain/counter strain steps of treatment
- Find a tenderpoint
- establish tenderness assessment/pain scale
- Place patient passively in a position that results int he greatest reduction of a tenderness at the point
- Maintain this position for 90 seconds while continuously monitoring the point
- Slowly return the patient passively to a neutral position
- Re-test for tenderness at the tender point
Facilitated Positional release (FPR) and Dx
Indirect method. Goal: decrease tissue hypertonicity (can be used on deep muscles)
Dx: increased gain in gamma motor neuron, muscle hypertonicity, segmental somatic dysfunction, TART
FPR (facilitated positional release) indications
Acute or chronic somatic dysfunctions
- Somatic dysfunctions with a neural component
- as a primary treatment or in conjunction with other approaches
- somatic dysfunctions in any area of the body
FPR contraindications
Absolute: absence of somatic dysfunction, lack of patient consent, Fx
Relative: herniated/bulging disc, vertebral artery disease, severe osteoporosis
FPR tissue texture treatment method(facilitated positional release)
1) The A-P spinal curve of treatment area is flattened.
2) Physician places the patient’s musculature in a relaxed position.
3) A facilitating force is applied
4) The position is held for 3-5 seconds
* quicker than counter strain and no tenderpoints
FPR Intervertebral motion restriction treatment
1) Segmental (vertebral) Dx is made
2) The A-P spinal curve of the treatment area is flattened
3) Physician places vertebra into a position that allows freedom of motion in all planes
4) A facilitating force is applied
5) position is held for 3-5 seconds
6) patient is re-evaluated
